E-Health: Technologic revolution meets regulatory constraint

Health Affairs

Volumn 19, Issue 6, 2000, Pages 124-131

  Fried, Bruce Merlin ^a   Weinreich, Gadi ^a   Cavalier, Gina M ^b   Lester, Kathleen J ^b  

^a Shaw Pittman   (United States)

^b Internet Hlthcare Coal E   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONFLICT OF INTEREST; HEALTH CARE COST; HEALTH CARE ORGANIZATION; HEALTH CARE QUALITY; HUMAN; INTERNET; LEGAL ASPECT; SOCIAL CONTROL; STANDARD; UNITED STATES;

CONFLICT OF INTEREST; HEALTH CARE COALITIONS; HEALTH CARE SECTOR; HUMANS; INTERNET; QUALITY ASSURANCE, HEALTH CARE; SOCIAL CONTROL, FORMAL; UNITED STATES;

EID: 0034332130     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.19.6.124     Document Type: Article

References (38)

1. A related content-based issue is that of liability for libel. For example, several Web sites are considering allowing consumers to rate their providers, with the results published on the site. If a provider believes it has been libeled by a patient, will the host of the site be responsible? As a U.S. Court of Appeals noted, 47 U.S. Code, sec. 230 provides federal immunity from liability for computer service providers who post information originating from a third party. See Ben Ezra, Weinstein, and Co. v America Online, Inc., 206 F.3d 980, 984-985 (10th Cir. 2000).
2. Another prominent industry leader is TRUSTe, . Because its principles primarily address confidentiality concerns, it is beyond the scope of our discussion.
3. See "Principles," HON Code of Conduct for Medical and Health Web Sites, 25 January 2000, (12 August 2000).
4. Ibid., "HONcode Membership Application" (4 July 2000), (12 August 2000).
5. See Health Internet Ethics: Ethical Principles for Offering Internet Health Services to Consumers, (12 August 2000).
6. Ibid.
7. Ibid.
8. See (12 August 2000).
9. Ibid.
10. See "Mission Statement," (12 August 2000).
11. See eHealth Code of Ethics, (12 August 2000).
12. Ibid.
13. Helga Rippen, director of medical informatics, Pfizer Health Solutions, and IHC steering group member, public remarks delivered 24 May 2000, Washington, D.C., upon release of the code.
14. Ibid.
15. Ibid.
16. The White House, The Framework for Global Electronic Commerce, 1 July 1997, (12 August 2000).
17. The two most prominent congressional efforts in the past few years are the Communications Decency Act (CDA), 47 U.S. Code, sec. 223, and the Children's Online Privacy Protection Act (COPPA), 47 U.S. Code, sec. 231. For FTC approaches, see 64 Federal Register 59888 (1999).
18. Robert Pitofsky, chairman, Federal Trade Commission, testimony before the Senate Governmental Affairs Subcommittee on Investigations (10 February 1998).
19. See Reno v ACLU, 521 U.S. 844 (1997) (defining the Internet as a form of communication with so few barriers that the Court will review restrictions upon it with strict scrutiny).
20. 47 U.S. Code, sec. 223.
21. Reno v ACLU, 844.
22. 47 U.S. Code, sec. 231; and 64 Federal Register 59888.
23. ACLU v Reno, 217 F.3d 162 (3d Cir. 2000).
24. E-health entities may find themselves the targets of such initiatives as they venture into providing health services that some could view as obscene. It is easy to imagine a mental health Web site that provides a chat room for teens dealing with depression in which the teens frankly discuss topics that others might view as indecent. If so, these laws raise concerns for such Web sites.
25. This test is derived from the Supreme Court's decision in Central Hudson Gas v Public Service Commission, 447 U.S. 557, 566 (1980), in which the Court invalidated a prohibition on advertisements by utility companies that promoted the use of electricity. Although the First Amendment commercial speech doctrine has been churning, the Court continues to rely upon the Central Hudson test as a benchmark for its analysis. See 44 Liquormart, Inc. v Rhode Island, 116 S.Ct. 1495 (1996). For a more detailed explanation of the fluctuating doctrine, see K.J. Lester, "Cow-boys, Camels, and Commercial Speech: Is the Tobacco Industry's Commodification of Childhood Protected by the First Amendment?" Northern Kentucky Low Review 24 (1997): 615, 642-648.
26. Pitofsky, testimony.
27. 15 U.S. Code, sec. 45(a).
28. Ibid., secs. 45(a), 53(b), and 56.
29. See, for example, FTC File no. 952-3331, 1 May 1997 (settling allegations that "free trial" offers resulted in unexpected charges for many consumers), (25 August 2000);
30. and FTC v The Mentor Network, Inc., FTC File no. X970015, 17 March 1997 (consent degree requiring defendants to pay $75,000 into a fund for consumer redress and barring defendants from operating any chain or pyramid marketing program), (25 August 2000).
31. These laws and their regulations are exceptionally complex. It was not possible to fully explore these policies in the space available. The authors encourage e-health entities to seek advice from competent health care counsel in developing their business plans and revenue models.
32. 42 U.S. Code, sec. 1320a-7b(b)(2). It also is illegal to "solicit" or "receive" remuneration for such purposes. Ibid., sec. 1320a-7b(b)(1). Many states have their own counterparts, some of which are even broader than federal law.
33. 64 Federal Register 63517 (1999).
34. Designated health services include laboratory, therapy, and radiology services; durable medical equipment; prosthetics and orthotics; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services. 42 U.S. Code, sec. 1395nn(h)(6).
35. Ibid., sec. 1395nn(a)(1)(B).
36. Ibid., sec. 1395nn(h)(5)(A)-(B).
37. 63 Federal Register 1659 (1998). We expect the final version of these regulations to be published shortly.
38. 42 U.S. Code, sec. 1320a-7a(a)(5).